Schedule X - Other Income - 2013

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File pg. 5
SOCIAL SECURITY NUMBER
FIRST NAME
M.I.
LAST NAME
Note: If reporting other income on Form 1, line 9 or Form 1-NR/PY, line 11 and/or claiming other deductions on Form 1, line 15, or Form 1-NR/PY,
line 19, you must complete and enclose the following schedule(s) with your re turn.
chedule X Other Income.
2013
Enclose with Form 1 or Form 1-NR/PY. o not cut or separate these schedules.
0 0
1
Alimony received (from U.S. return) (full- and part-year residents only; see instructions) . . . . . . . . .
1
0 0
2
Taxable IRA/Keogh and Roth IRA conversion distributions (from worksheet) . . . . . . . . . . . . . . . . . .
2
0 0
3
Other gambling winnings (sources other than Massachusetts state lottery). Not less than “0” . . .
3
Note: Gambling losses are not deductible under Massachusetts law. o not report Massachusetts
state lottery winnings here; instead, report them on Form 1, line 8b or Form 1-NR/PY, line 10b.
0 0
4
Fees and other 5.25% income. Not less than “0”. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5
Total other 5.25% income. Add lines 1 through 4. Not less than “0.” Enter here and on Form 1,
0 0
line 9 or Form 1-NR/PY, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
chedule Y Other Deductions.
Enclose with Form 1 or Form 1-NR/PY. o not cut or separate these schedules.
1
Allowable employee business expenses (from worksheet). (Non-residents and part-year residents,
0 0
this deduction must be related to income reported on Form 1-NR/PY). . . . . . . . . . . . . . . . . . . . . . . .
1
2
Penalty on early savings withdrawal (from U.S. return). (Nonresidents and part-year residents, this
0 0
deduction must be related to income reported on Form 1-NR/PY) . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3
Alimony paid (from U.S. return). Part-year residents, enter the amount paid while a Massachusetts
0 0
resident; nonresidents, multiply alimony paid by line 14g of Form 1-NR/PY . . . . . . . . . . . . . . . . . . .
3
4
Amounts excludible under MGL Ch. 41, sec. 111F or U.S. tax treaty included in Form 1, line 3 or
0 0
Form 1-NR/PY, line 5. Fill in applicable oval below . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
Income received by a firefighter or police officer incapacitated in the line of duty, per MGL Ch. 41, sec. 111F
Income exempt under U.S. tax treaty
0 0
5
Moving expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
0 0
6
Medical savings account deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
0 0
7
Self-employed health insurance deduction (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
0 0
8
Health savings accounts deduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9
Certain qualified deductions from U.S. Form 1040 (see instructions)
0 0
Certain business expenses from U.S. Form 1040 (see instructions) . . . . . . . . . . . . . . . . . . . . . .
9
10
Student loan interest deduction (from U.S. Form 1040 or 1040A; only if not claiming the same
0 0
expenses in line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
0 0
11
College Tuition Deduction (from worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
12
Undergraduate student loan interest deduction (only if not claiming the same expenses in line 10;
0 0
see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
13
Deductible amount of qualified contributory pension income from another state or political subdivi-
0 0
sion included in Form 1, line 4 or Form 1-NR/PY, line 6 (see instructions). . . . . . . . . . . . . . . . . . . .
13
0 0
14
Claim of right deduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
0 0
15
Commuter deduction (from worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
15
0 0
16
Human organ donation deduction (full-year residents only; see instructions). . . . . . . . . . . . . . . . . .
16
17
Total other deductions. Add lines 1 through 16. Enter here and on Form 1, line 15 or Form 1-NR/PY,
0 0
line 19 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
17

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